Delivery System Redesign

This brief discusses the fact that payment reform focusing on value and quality is driving change that is redefining the hospital’s role in the continuum of care and the health of the broader population. This brief also identifies opportunities for state policymakers to encourage the evolution of hospital community benefit policy in ways that complement and support the realignment of the hospital business model, proactively address the social determinants of health, and ultimately improve the health of the entire community.

As the U.S. population ages, the need for long-term services and supports (LTSS) is increasing, and policy makers are grappling with how to finance this huge expense. The ACA included a plan to enhance the private market with a national voluntary long-term care insurance program, but Congress repealed it before it launched. Now, there is a flurry of activity as groups develop new financing approaches. This new Alliance for Health Reform toolkit explains the current LTSS system, trends in the delivery of care, and the current policy challenges.

Social determinants of health have taken center stage in recent discussions of health policy in the wake of the ACA. Health care providers are being asked to extend the models' impact beyond costs and quality of health care into what has traditionally been beyond the providers' sphere of influence: the health outcomes of the population they serve. Although health policy makers have traditionally considered nonmedical influences on health to be the domain of other state agencies and nonprofit actors, a reconsideration of how the social determinants of health can be addressed within the current health policy landscape is underway. This report summarizes and synthesizes existing evidence about the impact of investing in social services and partnerships between health care and social services, paying special attention to the innovative models for improving health outcomes and reducing health care costs.

One of the barriers to reaching consensus on significant payment reforms has been the complex and confusing array of terminology that has been used to describe different payment systems. It is difficult for stakeholders to determine whether to support a proposal if they do not understand the words and abbreviations used to describe it, and it is difficult to reach agreement when the same words are used by different people to mean different things or when words are perceived by some stakeholders to mean something different than what was actually intended. This Payment Reform Glossary is designed to facilitate a better understanding of payment reform concepts and to create a foundation for a common language for developing and discussing payment reform concepts so they can be supported and implemented by all stakeholders — patients, providers, employers, health plans, and government agencies.

Delivery system and payment reform are dynamic and ever-evolving policy areas of state Medicaid programs; virtually every state has initiatives underway. This interactive map is designed to provide users with an environmental scan of the activity, to help introduce these complex concepts and also dive deeper. It allows users to explore specific initiatives more in depth, and it also provides related briefs that elucidate these concepts.